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The impact of trauma in an urban pediatric orthopaedic practice
W Timothy Ward1, Jeffrey A Rihn
1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA. wardtw@chp.edu
Insights
Pediatric orthopaedic trauma care is frequent, with fractures of the distal radius, forearm, tibia, and elbow being most common. This analysis of a single practice highlights the significant work involved in treating these pediatric fractures.
Area of Science:
- Orthopaedic Surgery
- Pediatric Trauma Care
- Health Services Research
Background:
- Previous national data exist on pediatric trauma admissions and ER visits.
- This study focuses on the specific workload of a single urban pediatric orthopaedic group practice.
Purpose of the Study:
- To document the frequency and work relative value units (RVUs) associated with pediatric orthopaedic trauma care.
- To analyze the distribution of trauma care within a pediatric orthopaedic practice.
Main Methods:
- Analysis of computerized billing records from a single pediatric orthopaedic practice (July 2004-June 2005).
- Categorization of office visits and operative procedures to identify trauma care components.
- Calculation of descriptive statistics, including RVUs generated from fracture care.
Main Results:
- The practice generated 36,771 RVUs, with 51% from the operating room and 49% from office visits.
- 1903 new fractures were seen, accounting for 32% of office RVUs. Distal radius, forearm, tibia, and elbow fractures were most common.
- Fracture care represented 32% of operating room RVUs. Elbow, tibia, and femur fractures were most frequently operated on, often using advanced fixation techniques.
Conclusions:
- This study quantifies the frequency and work RVUs for pediatric musculoskeletal injuries in an urban setting.
- The findings provide a snapshot of current pediatric orthopaedic practice trends.
- Data may inform future resource allocation and manpower planning for pediatric orthopaedic services in North America.
Background:
National data documenting the impact of pediatric trauma in general and of pediatric orthopaedic trauma in particular on the rates of hospital admissions and emergency-room visits have been reported. This study documents the frequency of and work involved in the care of pediatric orthopaedic trauma by a single urban pediatric orthopaedic group practice.
Methods:
The computerized billing records of a single practice group of 3.4 full-time-equivalent, fellowship-trained pediatric orthopaedic surgeons practicing in a freestanding pediatric hospital with a level-I trauma center were analyzed for one year (from July 2004 through June 2005). Every office visit and operative procedure was specifically sorted to determine the component of trauma care in the group's pediatric orthopaedic practice. Descriptive statistics, including the actual numbers and percentages of office fracture visits and operations for fracture care as well as the actual numbers and percentages of work relative value units generated by the physicians, are presented.
Results:
The practice generated 36,771 work relative value units, with 18,693 units (51%) from treatment provided in the operating room and 18,078 units (49%) from treatment provided in the office. A total of 1903 new fractures was seen and accounted for 5698 work relative value units (32% of all work relative value units for treatment provided in the office). The four fractures that were most frequently seen in the office were in the distal aspect of the radius (23%), forearm (14%), tibia (13%), and elbow (10%). Of the 18,693 work relative value units generated in the operating room, 5975 (32%) were from fracture care, representing the largest single category of work done in the operating room. Trauma-related operations were most commonly done for fractures of the elbow (25.3%), tibia (12%), femur (9.8%), forearm (5.5%), and the distal aspect of the radius (5%). Technically demanding fixation techniques, which are commonly used to treat fractures in adults, were frequently used, particularly for femoral and tibial fractures.
Conclusions And Clinical Relevance:
This study documents the frequency and work relative value of the care of musculoskeletal injuries in an urban pediatric orthopaedic practice in the outpatient and inpatient settings. It is a snapshot in time of current trends in pediatric orthopaedic practice, but these data may have implications for future resource allocation of the pediatric orthopaedic manpower in North America.
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